Transcript Chronic Shoulder Disorders

Chronic Shoulder
Disorders
Dr Mustafa Elsingergy
Consultant Orthopedic Surgeon
OBJECTIVES

TO KNOW COMMON CAUSES OF SHOULDER PAIN

HOW TO REACH THE DIAGOSIS OF DIFFERENT
DISORDERS CLINCALLY

DIFFERENT IMAGING MODALITIES AND THEIR
VALUES

MANAGEMENT OF EACH DISORDER
Shoulder Pain

INTRINSIC
DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC
DUE TO REFERRED PAIN FROM OUTSIDE THE
SHOULDER
Shoulder Pain

INTRINSIC
DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC
DUE TO REFERRED PAIN FROM OUTSIDE THE
SHOULDER
Shoulder Pain

INTRINSIC
DUE TO CAUSES IN THE SHOULDER REGION

EXTRINSIC
DUE TO REFERRED PAIN FROM OUTSIDE THE
SHOULDER
SHOULDER DISORDERS

DUE TO CAUSES RELATED TO :
1.
ROTATOR CUFF (RC)
2. SHOULDER CAPSULE
3. GLENOHUMERAL JOINT (GLJ)
4. SCAPULAR PROBLEMS
5. ACROMIOCLAVICULAR JOINT (ACJ)
ROTATOR CUFF

ANATOMY :
ORGINATE FROM THE SCAPULA
INSERT IN THE GT AND LT
PASS UNDER CORACOACROMIAL ARCH
SEPARATE FROM THE LIGAMENT BY BURSA
ROTATOR CUFF DISORDERS
(R.C.D)

ACUTE TENDENITIS

IMPINGEMENT SYNDROME

ROTATOR CUFF TEAR
R.C.D
ACUTE TENDINITIS

CLINICAL FEATURES
PAIN
TENDERNESS
PAINFUL ABDUCTION RANGE

X-RAY
NORMAL
AREA OF CALCIFICATION

TREATMENT
REST
NSAID
LOCAL INJECTION
R.C.D
IMPINGEMENT SYNDROME

CAUSES

CLINICAL FEATURES
•
PAIN
•
SHOULDER LOOKS NORMAL OR WASTED
•
TENDERNESS
•
DISTURBED GLENOHUMERAL RHYTHM
•
PAINFUL ABDUCTION ( 6O TO 120 )
•
NEER’S TEST (+VE)
•
HAWKIN’S TEST (+VE)
R.C.D
IMPINGEMENT SYNDROME

XRAY
•
CALCIFICATION
•
DEGENERATED ACJ

MRI
•
BURSITIS
•
THICKENING OF THE TENDON

TREATMENT
•
MILD: NSAID, LOCAL INJECTION
•
SEVERE: ARTHROSCOPY VS ACRMOIOPLASTY
R.C.D
ROTATOR CUFF TEAR

CAUSES
•
PREDISPOSING FACTOR
•
DEGENERATION: MIDDLE AGE
•
CHRONIC IRRITATION BY OSTEOPHYTE
•
UNDERLYING DISEASE ex. RHEUMATOID
•
PRECEPATATING FACTOR TRAUMA

TYPES: INCOMPLETE
COMPLETE
R.C.D
ROTATOR CUFF TEAR

CLINICAL FEATURES
•
TRAUMA, PAIN, LIMITED ABDUCTIOIN
•
AFTER FEW WEEKS:
INCOMPLETE TEAR: IMPROVEMENT OF PAIN AND ROM
COMPLETE TEAR: PARTIAL IMPROVEMENT OF PAIN AND
DECREASE OF ACTIVE RANGE
o
LOOK:
EARLY; NORMAL APPEARENCE
LATE; WASTING OF SUPRASPINATUS AND
INFRASPINATUS MUSCLES
o
FEEL
R.C.D
ROTATOR CUFF TEAR

CLINICAL FEATURE:
o
MOVE: INCOMPLETE TEAR; PAINFUL WEAK
COMPLETE; PASSIVE NOT PAINFUL, ACTIVE DROP
ARM SIGN
IMAGING:

XRAYS: EARLY NORMAL
LATE DEGENERATIVE CHANGES
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MRI IMAGE OF CHOICE
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TREAMENT: INCOMPLETE TEAR: PT, NSA ID
COMPLETE TEAR: SURGICAL REPAIR
BICEPS TENDON DISORDERS
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TENDENITES

PAIN
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TENDERNECE: BICEPITAL GROOVE

PIANFUL FORWAD FLEXTION
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TREAMENT: NSAID, LOCAL INJECTION
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TEAR OF LONG HEAD OF BICEPS TENDON

PAIN
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DEFORMITY OF BICEPS CONTOUR ( POPEYE’S ARM)
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NO NEED FOR TREAMENT
ADHESIVE CAPSULITIS
(FROZEN SHOULDER)

UNKNOWN PATHOGENESIS LEADS TO PAIN AND LIMITATION OF
MOVEMENT

TRAUMA OR RCD MAY BE CAUSES

CLINICAL FEATURE

PAIN

LIMITATION OF MOVEMENT IN ALL DIRECTIONS OF G-H RANGE

NATURAL HISTORY

PAIN AND LIMITATION OF MOVEMENT GRADUALLY INCREASE THEN
GRADUALLY DECREASE, TAKES 18 MONTHS
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TREATMENT

CONSERVATIVE VS ARHTROSCOPY
RECURRENT SHOULDER
INSTABILITY
TYPES

RECURRENT ANTERIOR DISLOCATION (RAD)
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RECURENT POSTERIOR SUBLUXATION(rare)

MULTIDIRECTIONAL INSTABILITY (MDI)
RECURRENT SHOULDER
INSTABILITY

RECURRENT ANTERIOR DISLOCATION (RAD):
MOST COMMON
H/O ACUTE DISLOCATION
APPREHENSION TEST (+VE)
IMAGE:
HILL SACHUS LESION
BANKART LESION
RECURRENT SHOULDER
INSTABILITY
MULTIDIRECTIONAL INSTABILITY :
GENERALISED LIGAMENTOUS LAXITY
SALUCUS SIGN (+VE)
RECURRENT SHOULDER
INSTABILITY

RECURRENT ANTERIOR DISLOCATION (RAD)

MULTIDIRECTIONAL INSTABILITY (MDI)
RAD
TRAUMATIC
APREHENSIVE TEST
SURGICAL TREAMENT
MDI
ATRAUMATIC
SULCUS SIGN POSITIVE
PT
GLENOHUMERAL JOINT
DISORDER

TB

RHEUMATOID

OSTEOARHTERITIS

MIL WAUKEE
GLENOHUMERAL
RHEUMATOID ARTHERITIS

CLINICAL FEATURE

GENERALIZED ARTHERITIS AFFECTING OTHER JOINTS

PIAN AND LIMITATION OF MOVEMENT

PAINFUL PASSIVE MOVEMENT AND LIMITED ACTIVE
MOVEMENT

LAB INVESTIGATION: +VE RHEUMATOID FACTOR

XRAY:

LOSS OF ARTICULAR SPACE

PREARTICULAR EROSION
GLENOHUMERAL
OSTEOARTHERITIS

USUALLY FOLLOW OTHER PATHOLOGY eg. TRAUMA, RHEUMATOID
ARTHERITIS OR RC TEARS

CLINICAL FEATURE

PAINFUL MOVEMENT

WASTING THE SHOULDER MUSCLE

TENDER JOINT LINE

LIMITED ROM

XRAY

LOSS OF JOINT SPACE

SUBCONDIRAL SCHLEROSIS

TREAMENT
ACROMIOCLAVICULAR
DISORDERS

INSTABBILITY

ARTHERITIS
SCAPULAR DISORDERS

SPRENGEL SHOULDER:
CONGGENITAL

WINGING OF SCAPULA:
WEAK SERRATU ANT MUSCLE
Shoulder SUMMARY

Shoulder Symptoms
Pain
Stiffness
Instability
Deformity
Loss of Function

Shoulder EXAMINATIONS
Look
Feel
Move
Special Tests

Investigation
Lab
Images

Treatment
Conservative
surgical
THANK YOU